Managua Trip Report 2013

Bev and I begin our 12th dental mission to Nicaragua by catching the Red Eye to Houston on December 30, leaving at 11:57 PM. We arrive in Managua shortly after noon, checking into the Best Western across the street from the Managua Airport. New Year’s Eve will be spent in the hotel.

There is much preparation for a dental mission, especially when you are bringing in two dental teams. The hotels and vehicles have to booked, arrangements for sleeping areas for the team in the village, hiring of local women to do the cooking for lunch and dinner, ensuring we have enough bottled water and sufficient gasoline to operate our compressor and during power outages, our generator.

The village we will be working in is El Chaparral, which is 5 hours northeast of Managua. The area is the beginning of the mountains and we are about 2 km from the Honduras border. It is the furthest village we have to travel to, and it has been five years since we last provided dental services to the area. The village is in the province of Chinandega and we are providing services to some of the poorest villages in the poorest province in the second poorest country in the Western Hemisphere.

Bev and I have to transport our equipment from the village of Achuapa to El Chaparral which is about 2.5 hours away. We roughly set up the clinic. We are shown where we will be sleeping. We luck out in that it is a new home being built for a person who is working in Spain. We will have it for 5 weeks. It is cement home with open rafters and a tin roof. It is one of the better places that we have been provided for sleeping. Scissor beds are provided (woven plastic stretched over two beams) which are quite comfortable. The only difficult part is the outhouse which is down a narrow, steep path which will be tricky to negotiate at night.

When team one arrives, they finish setting up the clinic in preparation for our first patient on Monday morning. We will work from 8:00 AM to 5:00 PM. It is dark by 6:00 PM and it becomes difficult to see in the building we are working in. The building is an adobe building with tile floor and clay tile roof with open rafters. It is an excellent area for our dental clinic which has three dentists, a hygienist and our sterilizing area. Each day the temperature is between 32 and 34 above C.

Each day there is a designated village to attend the clinic. It can be anywhere from a five-minute walk to up to a two and half hour walk. There are no vehicles to drive to the clinic. They may catch the bus to El Chaparral and then walk 10 minutes to the clinic. The lucky ones will have a horse to ride to the clinic. The further away the people come, the poorer the village. We see very few mouths that do not have cavities. An estimate would say that 80% of the patients attending the clinic will have at least 1 to 2 anterior restorations to do, besides a number of posterior teeth to restore.

We see a variety of young and old. I have a down syndrome girl who is 15 years that returns for the third time to our clinic. She was 3 years when we initially saw her. There is a down syndrome man who comes to have his teeth cleaned, we saw him 12 years ago. A blind girl of 18 comes to have her teeth cleaned. How she manages these treacherous roads is remarkable. A little 3-year girl comes and requires 5 teeth extracted. Our dentists do restorations, extractions and some do endo on anterior teeth. Everyone has a cleaning and are given a toothbrush and floss after their appointment. They are then brought to the gift table where they can choose at least two gifts, from lip gloss, to body creams, bags, hats, toys, etc.

People begin to line up at 6:00 AM, even though the clinic does not begin until 8:00 AM. We are averaging over 30 patients a day and most days are able to get through the list. People have to pay 20 cordoba’s ($0.75) to see the dentist, but if they have no money we will still see them. The sponsoring group will keep the money to help their group with different projects.

Group two arrives after a few days off for Bev and I. We are missing the hygienist who has come down with pneumonia 5 days prior to leaving Edmonton. She was not cleared to fly. Each group works for a two week period. We travel to a larger center on the weekends for a two night R&R where we have beds, sit down toilets and warm showers.

When in the village, the only time you see the sun is when going outside to walk to the outhouse. We do not have much time to walk around as it gets dark very quickly and we are in very hilly terrain. To drive a vehicle up the hill requires 4 wheel drive.

Our poorest village is the village of Palazzo Jueves. Everyone has multiple teeth that require restorations. Not very many have even seen a dentist and if they have it is to have a tooth extracted. Dr. Aucoin has a special needs older lady who requires all of her teeth removed. Most are decayed roots, badly broken down teeth, 25 in all. A young, pretty girl sits in my chair. She is 13 years old. She opens her mouth, she has 28 teeth and every one of them are badly decayed. Both her upper and lower anterior teeth have the hour shaped badly decayed teeth. I do 7 restorations on her upper teeth and extract 3 hopeless teeth. I tell her to return so that we can at least restore her lower anterior teeth. She and the other lady and her friend then leave for the village which is a two and half hour walk. They will be walking in the dark for most of the return trip as it after 5:00 PM when we are finished.

Dr Jim Thomas works his magic

Most of these people do not know what it is to eat without pain. This is normal. It is driven home when a young lady, 21 years wants some back teeth pulled. I point out other teeth that we can restore (which we do), especially in the anterior region, but that was not her main concern. She just wanted the teeth that hurt out. The poorer the village the more teeth we have to extract. Our motto of “Change a Smile, Change a Life” is driven home with the number of anterior teeth we restore. People who were hiding their mouths when smiling had no problems smiling when they left our clinic.

Probably the person that touched me the most was Naomi, an 8-year-old girl who lived next door to where we were sleeping. I first met her when she walked over and said hi to me. I asked her how she was, and she said fine thank and asked me how I was. She had an infectious smile. Jayson our interpreter, McGyver person would go up to the house early, and Naomi would come over and ask him how his day was, and if he was tired. She explained how every morning she got up, ate breakfast, did her toiletry, made her bed, and swept the house. As it was their holiday time, then she was allowed to go and play.

I saw Naomi in the clinic and she required 4 teeth to be extracted on the left and 3 on the right. We took the 4 as they were bothering her the most. She was an excellent patient. Saw her later and she gave me her winning smile. We saw her again two days later for the right side, there were a few tears as now she knew what to expect, but good behaviour is what she had been taught and opened her mouth wide as the tears rolled down her cheeks. We removed the teeth and she gave me a smile before she left. Later that evening, they had a farewell party for us, and Naomi came over and gave me a hug. There was dancing, and she was up dancing with her friend.

Naomi – 8 years of age, El Chaparral

Why do I mention her? Well, her mother had passed away a year earlier giving birth When asked if she had any brothers or sisters, she would say, no, they all died. She is being raised by her father and extended family, aunts, uncles, older cousins. If a person ever had a reason to feel sorry for herself, Naomi would be one. She was such an example of a positive person, happy, outgoing at 8 years of age ready to tackle the world with her great little smile. You are humbled that she considered you a friend, no strings attached.

There always seems to be a story that will inspire you. You want to return so you can learn that next story.